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Home My WebLink AboutLITTLE BEAR BLK 1 LT 76 L~ ~Z Z PERMIT NO. FIPF'L. I CRN"I' I..OCFI'I' ~ ON I..EGRL E:Zo.:LO WEL, L_E;LE'-r' C*l' L. CFI" 51 ZE H Zi',,I]:HUI~I [:,ISTRI'.,ICE BETWEEN FI WELL RND FIl'4h,' ON.-.SIl% 5;EWFIGE :LOO F:E:ET FOR R PR :i[ 'v'FITE WEI..L. OF,' ;288 FEET FOF.". t::~ PUBLIC 1,4EI_.,L. IqE:L.L. LOGS FIRE RErZJ'[RED FIND i','IUST BIE RETtJF..'NED TO THE DEPFIR"f'HENT I.,.I~Tt4]:t'.~ OF THE t4ELL COI"IPLETION. :i.-.iP[E[:: % F :il: CRT 1_:' ONS FIND C'ONSTRUCT I ON [) I RC~iRRI"I5 I:'I[;.'.E FIVFI :[ L.RBL. E TO :r. NSTRLLRT 1' ON, I CEF.:TIF"r' THRT Z: I RH FRMILIRR ,t4I"f'H THE RE':QUIREMEI",ITS FOR ON-SITE E;IE!4ERr'.S FIN[:, [,IELI...S; Pi:S 'SET F'ORTH B"r' THE I'IUNICIPRLIT"r' OF RNCHORFIGE. ,.~:. I WILL, INS;,TFILL THE :,'r:,l'El"l II',1 I::ICCOF.:DRNCE 1.4ITFI THE '" T Gl' lET'" ~ FIF'PL I C:FINT E:D I;'. I I'-~NE F.: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date A-?,-~ / M'7.` I'~g 7 GENERAL INFORMATION (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~¢~q~ (¢[(~¢ Telephone: Home Applicant Address ~¢~/ ~6Z ~ Applicant is (check one): Lending Institution ~; Owner/~uilder ~; Buyer ~; Other ~ (explain); Business (d) Lending Institution ,~o r./~/~t~ 0/,.. h'for' ~,¢t~,¢_. Telephone ~¢ ~ -~¢ Address ~00 ~. ~or ~ ~or~.. ~ ~ (e) Real Estate Company and Agent N~ ~, (R~c~) Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family[] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) '~tJOM s,Jeeu!bue leUO!SS@J, oJd 8q~ u] SUO!$S!LUO ,lO S JO J J@ JO,t elq!suodseJ lou s! eSeJOqOUV Jo &!led!o!unlgl eq.l. 'panss! s! m, eou!lJoo e @JO,teq e~ep ez,qeue Jo suo!~oedsu! ~onpuo3 ~ou op d3HCI ,to see/[OldUJ=J 's~ueLueJ!nbeJ e~els pue leJapej u!~peo Als!les oh JepJo u! suoBn~!~,su! 8u!puel J!@q~ puc SeLUOq ,tO sJ@seqoJnd ol Asel~noo e se s!ql s@op cl3HG eq/ 'e>tSel¥ jo e~elS eqi u! peJ@lS!SeJ Jeeu!Sue leUO!SSe~OJd ~u@puedepu! ue Aq e^oqe g qdm§med u! ue^!8 suoce~u@seJdeJ @q~ uodn ,(lalOS peseq se~eOgilJeO le^oJddv A~poq~n¥ q~leeH senss! (d3HCI) uo!loe~OJd le~UeUJUOJ!^U3 pue q~leeH ,to ~ueculJedecl eSmoqou¥ jo ,q!led!ounlAI eq_L NOl~n¥o leAoJdd¥ leUO!l!puoo ,to swJe/ leUO!l!puoo poAoJddes!a -~,~ pe^oJddV ..... Xq SLUOOJpoq (¢ r//~¢'/~. JO~ poAoJddv '9 .g WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) (] ] Ai ] AUT.OR,TY APP.OVAL ~"~ CHECKLIST - FEBRUARY 1984 264-4720 Lr 6[ Udv ('~-'7~,.~ Legal Description: /'" c~ 1~ NOi$1AiO'~J~DiA~i~t~iViN~WNO~IIAN~ /.- I~¢' I~ ~ ~ / ~O~OHgNV ~0 Well Classification Well Log Present (Y/N) _ Total Depth ¢'O ' Static Water Level . Casing Height Above Ground Pm'~'~'~"~ If A, B; C, D.E.C. Approved (Y/N) ~ Date Completed _[ ¢--- ,/E.~ ,/7 ¢ Yield Cased to ~ ' Depth of Grouting ¥* Pump Set At ~ 'f" Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) _ ~ Separation Distances from Well: To Septic/Holding Tank on Lot t'4.~. (74f,/~¢ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments $ -/'",~,~ ~ Depression Around Wellhead (Y/N) t¢ ~"¢~' """ ) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B, SEPTIC/HOLDING'rANK DATA Date Installed Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA ~. ,4. ~ ?~/~ t'~ ~'~' ~'"} Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION N,A', Date installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~ ~--'~ Date Company F[~/'/~? '1-~¢/~ ~ MOA No. ReceiptNo. ~ ~ ~ ~/~OO'~ 7 Date of Payment ~/¢~ ¢ 7 Amount: $ /O ¢ ,~~,~:...'~ ~ ~" ...... A ,,~:]c~,.~,~r¢~, Engineer's Seal Page 2 of 2 72-026 (11/84) I Telephone 264-4720 AR ~l~[~?lO~g: Oompl~te ~11 parts on pa~ 1. In~omploto r~sB ~ill not bo pro~,ss~d. Please allow ~n {10} davs for prooessin~. MAIEING ADDRESS · PROPERT~ R~SIDEN~ (Ifd[}ferCnt__~~from abGve}~ ~ PHONE 2, BUYER ~ PHONE MAILING ADDRESS LENDING INSTITUTIO~ " MAI LIN~ACDR~SS ~/ , ~ . SB, LEGAL DESCRIPTION TREE'r, LOCATI,I~'N ' - ' / - -' ' .~ - - - ' ~- ¢ ' 6, TYPE OF RESIDENCE R~ ~"'L I I ----,,~ NUMBER OFBEDROO~IS ~ S INGLEFAMILY ~-v~g/f~j /YIY4P' [~] ?nwe° [-J FF~,Uer [] Other [] MULTIPLE FAMILY ~ Three [] Six 7, WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8, SEWAGE DISPOSAL SYSTEM []' INDIV DUAL/ON.SITE'~ ~ PUBLIC'UTILITY ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) **If individual/on-site, give installation date If system is over two (2} years old an adequacy test ~s required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROC ESSING CAN BE INITIATED, 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY .:.. DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR iNSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE ~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY ~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED/j,_%,~ ~) ~ \o_~L~ ~------~, ~ . 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED '1~] PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E3~]/APPROV ED FORL-':'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE B~ LEGAL DESCRIPTION 72-010 (Rev. 3/78) ~ ~ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality ~ 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~) ~ Date Received January 11, 1977 l. Approval requested by: Amfac Mortgage Mailing Address: 705 West 6th Avenue Phone: 277-8588 2. Property Owner: Lawrence Sebring Phone: 344-7474 Mailing Address: 4041 Truro 3. Legal Description: Lot 7 Block 1 Little Bear Subdivision 4. Location: Baby Bear Place, off of East 68th Avenue 5. Type of facility to be inspected Single Family No. of bedrooms 3 6. Well Data: Permit ~76308 ~/~(~ ~'~ A. Type ~/<~l~$b~ B. Depth ?0] C. Construction ~-~1/~,~_~~ D. Bacterial Analysis ~-' , 7. Sewage Disposal System: A. Installed Public B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re¢ st for Approval of Individual S }r &'Water Facilities Legal Description Lot 7 Block 1 Little Bear Subdivision Comments APproved~~~~ Disapproved Date /~'~// Approve/Valid for one year from date signed Greater Anchorage ~ea Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily, SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION {3P..J~;, (~ NEALTH & 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 3. Name of Buyer: Mailing Address: ~ 4. Name of Lending Institution: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: CMRO VA FHA Property Owner: Z ~c~ ~"~ ¢'~-' C~-- ~'~---~e/~ ~ ~'~ ~f,-~ Mailing Address.. z~ y~ y~ ~'¢-,¢,,'E0 ~/'~"~a;?~h~o2ne: JAN t t ~77 REC£1 . D CONV. Day Phone: ,~ ~3. ~2-~,~_~_, Phone: Name of Realtor or Agent: ~1 ~ ~ ~ ~/~ Mailing Address: ~/~ ~/~ ~'~ Phone: Legal Description: ~ ~ ~/~ / ~ ,'~ 7. Type of Facility to be Inspected: No. Bdrms. ,-~ Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well °~ ! (~individual / Sewage Disposal System Type of System: ~ity,. _ If Individual, date of installation Individual (on-site) 72-003(3/76)